Nursing Groups Work for National APRN Standards

The barriers that prevent advanced practice registered nurses from practicing to their full capabilities are coming down as states begin to adopt national standards to educate, license, accredit and certify nurse midwives, nurse anesthetists, clinical nurse specialists and nurse practitioners.

Members of state boards of nursing and nursing associations, national nursing leaders, and healthcare policy experts shared ideas on how to adopt an already-agreed-upon national model for the licensing and regulation of APRNs at a summit in San Diego starting Jan. 13 sponsored by the National Council of State Boards of Nursing.

“Everybody understands that we need to lift these barriers,” says Ann L. O’Sullivan, CRNP, PhD, FAAN, president of the Pennsylvania State Board of Nursing and professor of primary care nursing, University of Pennsylvania.

The NCSBN has been working for several years now with various nursing organizations on uniform standards of APRN licensure, accreditation, certification and education standards. In 2008, about 50 nursing organizations unanimously approved a consensus model of legislative language. Once adopted by all 50 states, the consensus will allow APRNs to perform the same services from state to state, such as prescribing medications and providing primary care. APRNs will have more mobility to practice in different states, and Americans will have more access to healthcare, particularly those who live in underserved populations, says Mary Ann Alexander, RN, PhD, chief officer of nursing regulation for the NCSBN.

Each state controls how APRNs are licensed, accredited, certified and educated. In some states, such as Colorado, APRNs practice more independently than in more restrictive states, such as Illinois and Pennsylvania.

The consensus model eliminates some of the most controversial restrictions on APRNs, including the requirement that APRNs work in collaboration with physicians and that they have limited prescribing authority.

To standardize APRN licensure and regulation, each state needs to change its laws and rules or regulations to follow the consensus model, but each state will continue to license its own APRNs, Alexander says. “Each state has to make the decision that they are going to do it [adopt the consensus model] and they have to do it themselves,” Alexander says. “The NCSBN is providing the resources to help them adopt the consensus model and are encouraging them to build statewide, grass-roots coalitions.”

Some states are further along than others in achieving this goal. “It varies from state to state,” Alexander says. For example, Maryland recently eliminated collaborative practice with physicians as a requirement for APRNs.

The goal is to have all states adopt the consensus model by 2015, but it actually might take a few years more, O’Sullivan says. However, she believes the amount of research now available showing the effectiveness of APRNs in improving access to care while saving money and the support of major think tanks and organizations, such as the Institute of Medicine and Robert Woods Johnson Foundation, will propel the consensus movement forward.

AARP is one of those groups that believes consumers should have access to APRNs who can deliver high-quality care. “We commend the National Council of State Boards of Nursing for their efforts to offer consumers this assurance by working with experts across the states to agree on what it takes to deliver care at the APRN level,” says Susan C. Reinhard, RN, PhD, FAAN, senior vice president and director, AARP Public Policy Institute and chief strategist, Center to Champion Nursing in America.

“Assurances that these nurses have achieved the high levels of education and training needed to deliver this care is essential.”

Every APRN in the country needs to be aware of the consensus and hopefully will help their state boards and local nursing associations and organizations work toward adoption of the proposed legislative language, O’Sullivan and Alexander say.

“We want nurses to know the power and influence they have when they join together and unite as one,” says Alexander. “That’s the theme of this summit — The Campaign for Consensus: Uniting APRNs, Promoting Uniformity, and Fostering Collaboration.”

O’Sullivan also encourages APRNs to review their own licensing and credentialing in anticipation of states adopting the consensus model. They might need to obtain new or updated education and certification to be in compliance with the new standards, she says. “If you do not have national certification, that is the first thing I would do,” O’Sullivan says.

One of the biggest obstacles to achieving consensus will come from national and local medical associations, particularly the American Medical Association, which has long fought the expansion of APRNs’ scope of practice, says O’Sullivan. But she says most individual physicians are in favor of APRNs practicing to their full capabilities.

APRNs practicing within their full scopes also is the recommendation of the Institute of Medicine’s report The Future of Nursing: Leading Change, Advancing Health, released this past October. The report had four key messages, one of which was that “Nurses should practice to the full extent of their education and training.”

The new healthcare reform laws also calls for APRNs to practice to their full extent in order to improve access to care, particularly in underserved areas, and to provide more access to primary care practice.

For more information about the APRN Consensus Model go to the NCBSN’s website at www.ncsbn.org.